Three cases of attempted suicide by ingestion of nicotine liquid used in e-cigarettes

(Ingestion of up to 1500ml of e-liquid solution by a 36 y.o. adult shown to be non-fatal)

Objective:
We report three cases (in two persons) concerning deliberate ingestion in attempted suicide. The Poisons Information Center in Denmark is experiencing an increasing number of calls concerning intake of nicotine liquid used for electronic cigarettes. Most cases concern accidental intake in children.

Case series:Case 1. Woman, age 36, admitted to a psychiatric ward, who had ingested 20 mL of nicotine liquid labelled as containing 18 mg2) to commit suicide. The Poisons Information Center was contacted 10 minutes after intake. The patient presented no symptoms. The patient was admitted to the emergency ward for treatment with activated charcoal.

Case 3. Male, age 13, ingested 3 mL of nicotine liquid, no information about concentration, to commit suicide. Fifteen minutes after ingestion symptoms were nausea and shivering. He was treated with activated charcoal and 1 hour after ingestion symptoms were decreasing. bP113/76, P 84.

Conclusion:
Nicotine liquid for e-cigarettes is imported to Denmark via the Internet. The concentrations in the different products vary. Nicotine fluid products with concentrations up to 100 mg/mL nicotine are distributed in cans containing 5 litres! Symptoms develop shortly after ingestion (minutes). The symptoms after ingestion vary. In milder cases: nausea, vomiting, dizziness, headache, tremor, diaphoresis, tachycardia, pallor, and hypertension. In more severe cases: seizures, confusion, weakness, bradycardia, hypotension, and respiratory paralysis3). The lethal dose in adults has been estimated: 40 to 60 mg.4) Treatment is symptomatic. In cases where the patient is not already vomiting activated charcoal can be considered. More similar cases are expected as the use of e-cigarettes increases.